Rita Duarte Vieira

Abstract
The progressive and complex nature of Parkinson's disease (PD) may largely benefit from regular and personalised monitoring, which is beyond the current clinical practice and routinely available systems. This paper proposes a simple and effective system to address this issue by using a wearable device to quantify a key PD's motor symptom - gait impairment as a proof-of-concept for a future broader approach. In this study, 60 inertial signals were collected from the ankle in 41 PD patients during a clinical standard gait assessment exercise. Each exercise iteration was classified by a specialised neurologist based on the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). A signal processing and feature extraction pipeline was employed to characterise gait, followed by a statistical analysis of their ability to differentiate between the 5 levels of impairment. The results revealed that 4 of the 8 studied features exhibited high discriminatory power between different severity levels of gait impairment, with statistical significance. The distinguishing capability of these 4 extracted features - gait consistency, rotation angle, mean height and length of steps - holds great promise for the development of a gait severity quantification remote monitoring for PD patients at home or on the move, proving the concept of the usefulness of wearable devices for regular and personalised PD symptom monitoring.

Abstract
Parkinson's Disease (PD) is a neurological disease that progresses over time and causes severe motor symptoms. Therefore, treating PD requires constant patient monitoring, which may turn clinical practice overwhelming, preventing its practical implementation, and raising the need for patient monitoring outside the clinical setting. The iHandU system described in this paper fulfils this need by providing an objective way to quantify motor symptoms of PD in non-clinical settings. It integrates an innovative real-time assessment of the severity of motor symptoms based on signal processing and Machine Learning models that mimic the clinical severity classification scales used in practice and allows for a more continuous and personalized therapy planning and management by doctors, through the use of a web dashboard user-friendly interface. This system, recently tested at 5 patients' homes, has shown promising results as a PD patient management digital platform, reaching a usability score of 83.9% (A grade) based on the System Usability Scale (SUS). Such a level shows a strong alignment between user needs, expectations and functionalities. This study highlights the potential of the used system as a Patient Management Tool showing a case study from an ongoing clinical study. By giving additional information to the doctors with features beyond the semi-quantitative rating scales currently used, allowing a more optimized and continuous PD symptom management, it will be possible to advance PD management further.

Abstract